Do the Current Guidelines for Heart Failure Diagnosis and Treatment Fit with Clinical Complexity?

Abstract

Heart failure (HF) is a clinical syndrome defined by specific symptoms and signs due to structural and/or functional heart abnormalities, which lead to inadequate cardiac output and/or increased intraventricular filling pressure. Importantly, HF becomes progressively a multisystemic disease. However, in August 2021, the European Society of Cardiology published the new Guidelines for the diagnosis and treatment of acute and chronic HF, according to which the left ventricular ejection fraction (LVEF) continues to represent the pivotal parameter for HF patients’ evaluation, risk stratification and therapeutic management despite its limitations are well known. Indeed, HF has a complex pathophysiology because it first involves the heart, progressively becoming a multisystemic disease, leading to multiorgan failure and death. In these terms, HF is comparable to cancer. As for cancer, surviving, morbidity and hospitalisation are related not only to the primary neoplastic mass but mainly to the metastatic involvement. In HF, multiorgan involvement has a great impact on prognosis, and multiorgan protective therapies are equally important as conventional cardioprotective therapies. In the light of these considerations, a revision of the HF concept is needed, starting from its definition up to its therapy, to overcome the old and simplistic HF perspective.

Clinical Support through Telemedicine in Heart Failure Outpatients during the COVID-19 Pandemic Period: Results of a 12-Months Follow Up

“…Many targets have been achieved and many more are still to be pursued regarding the virtual follow up of HF patients: (i) the possibility of following up with all patients discharged after a hospitalization, according with the times suggested by the Guidelines [ 1 ] and major clinical trials, in order to prevent disease exacerbation and HF progression; (ii) the possibility of stratifying HF patients, identifying patients at short-term risk of disease exacerbation who can benefit from a long-term virtual follow up and reserving in-person visits for high-risk patients; (iii) the possibility of titrating therapy quickly, as suggested by the Guidelines [ 1 ], and improving treatment adherence [ 42 ]; (iv) the possibility of prescribing further exams to complete a diagnostic path; (v) the possibility of relieving the congestion of hospital HF outpatients’ services, reducing waiting time. These aspects may bring benefits in terms of patients’ care, hospital organization, and healthcare costs [ 43 ].…”

20 Years of Real-World Data to Estimate the Prevalence of Heart Failure and Its Subtypes in an Unselected Population of Integrated Care Units

“…HF is a clinical multisystemic syndrome defined by specific symptoms and signs due to structural and/or functional heart abnormalities, which lead to inadequate cardiac output and/or increased intraventricular filling pressure [ 31 ]. In this study, we aimed to assess the prevalence of HF and its subtypes in a Portuguese center, as well as associated risk factors, such as T2D.…”

Quality of Life in Older Patients after a Heart Failure Hospitalization: Results from the SENECOR Study

“…This could be explained by a potential improvement in LVEF over time in the group with a lower baseline LVEF, which could be associated with improvements in HRQoL. However, it could also reflect the several pitfalls that the actual classification of HF based on LVEF values has [ 35 ]. Moreover, in our study, a trend towards a lower proportion of all-cause hospitalization was found in the group with HRQoL improvement.…”